Bizarre parosteal osteochondromatous proliferations of the temporal region: a case report.

Bizarre parosteal osteochondromatous proliferations (BPOPs) are distinct clinical-pathological entities that demonstrate combinations of atypical-appearing osseous and chondromatous tissues. These lesions are usually reactive in nature. Histopathologically, 'bizarre' cartilage is a characteristic feature of this lesion. BPOPs usually represent slow-growing painless bony hard protuberances that arise from the surface of affected bone cortices, typically the metacarpals, metatarsals, and phalanges. The occurrence of these lesions in the skull and jaws is sporadic. This case report highlights the clinical presentation, histopathological characteristics, and management of BPOP arising from the supraorbital rim in a 61-year-old female patient.

Basal cell carcinoma arising over lesion of discoid lupus erythematosus: a rare occurrence.

Although the association of discoid lupus erythematosus (DLE) with squamous cell carcinoma has been described in the literature, coexistence with a basal cell carcinoma is very rare. The indolent and non-pruritic nature of the lesion cause it often to be diagnosed at the late stage of the disease. Long-standing photosensitivity and chronic inflammation later lead to scarring and hypopigmentation, which are considered as the risk factors for the malignant changes over DLE. Incisional biopsy is often performed from the erythematosus lesion which does not respond to medical treatment. Here we have reported a rare case of basal cell carcinoma of the skin developing in the background of long-standing DLE, which was successfully managed with cold knife local excision.

Calcifying epithelial odontogenic tumor: a clinico-radio-pathological dilemma.

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasm of mandible in adults. The presentation of this entity is varied and often confused with a variety of mucosal and jaw lesions and clinical, radiological, and pathological feature of CEOT often-mimic malignancy. The objective of this report is to highlight the clinical features and radiological findings which should arouse suspicion of a benign lesion and importance of providing adequate clinical information to the pathologist to attain accurate diagnosis.We discussed two cases with tumors located in the maxilla. Both presented as expansile lesions with one biopsy proven squamous cell carcinoma. Both were pursued with clinico-radiological suspicion of benign lesions and confirmed with pathological correlation of histology and immunohistochemistry as CEOT. Therefore a High index of suspicion and clinico-radiological information are the key feature for diagnosis of this rare tumor.

The Role of Pregnancy Intention in HIV Prevention in South Africa: a Proposed Model for Policy and Practice

Mother-to-child transmission is a continuing source of new HIV infections in South Africa. The paper posits that insight into the socio-cultural; behavioural; environmental and economic factors that sustain the HIV epidemic is as important as understanding the biological causes of the disease when planning and implementing interventions to prevent and reduce perinatal transmission. Furthermore; understanding the pregnancy intentions of individuals in areas of endemic HIV/AIDS is vital for providing the best care for individuals who are HIV-positive. This paper suggests a model for types of support and interventions that are relative to the intention of HIV-positive women or couples to become pregnant. Included among these are interventions for prevention of unwanted pregnancy; prevention of transmission of HIV; protection of the infant; and protection of the mother

Battering and breastfeeding in a WIC population.

The study reported in this paper was based on the hypothesis that women who are victims of domestic violence may be less likely to select breastfeeding than women who are not abused. Informed consent was obtained from 212 women at 2 Women, Infants and Children (WIC) Nutritional Supplemental Program clinics in the Midwestern United States. The Abuse Assessment Screen was administered by interview and women were also questioned about intended feeding choice and whether they had breastfed any previous children. No association was found between present or previous abuse and infant-feeding choice. Nevertheless, the findings of this study can be considered important, for two reasons: (1) this was an initial inquiry examining the relationship between having been abused and ability to choose the feeding method of a newborn; and (2) women in the sample who reported present or current abuse were able to breastfeed their infants in the same proportion as those who did not report abuse, which suggests that a woman's concern for her child overcomes her possible fears of control by the batterer.

Pregnancy intention and pregnancy happiness: are they different?

OBJECTIVES: This study examines the relationship among pregnancy intention and attitudes, inconsistent contraceptive use, and plans for potential pregnancy among 311 women who presented at local health departments to seek a pregnancy test and for whom a pregnancy would be unintended. METHODS: Women were surveyed prior to receiving pregnancy tests. Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies. Frequency distributions and chi-square tests were computed to examine and compare rates of happiness about the pregnancy among women with mistimed or unwanted pregnancy and to compare rates of inconsistent contraceptive use and plans for the pregnancy by intention and level of happiness. RESULTS: Although all of the women selected for our sample stated that their pregnancies would be unintended, almost half (46%) were inconsistent contraceptive users. Further, 48% reported that they would be somewhat or very happy about a pregnancy. The proportion of women who were uncertain about the future of a pregnancy and who considered adoption or abortion was highest among those for whom a potential pregnancy was mistimed and who were unhappy about the pregnancy. CONCLUSIONS: Differentiating between pregnancy intention and happiness has practice implications for family planning and prenatal providers. Additional research should further elaborate these distinctions.

Factors affecting contraceptive use in women seeking pregnancy tests: Missouri, 1997.

CONTEXT: If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives. METHODS: A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race. RESULTS: In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item--worry over the potential side effects of the hormonal injectable contraceptive--did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues. CONCLUSION: Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.

Impact of perceived stress, major life events and pregnancy attitudes on low birth weight.

CONTEXT: While low birth weight is the leading cause of infant mortality and morbidity, the factors influencing low birth weight are not well understood. In particular, the relationship between stressful life events and birth outcomes is unclear. It is important for health care providers to better understand the impact of stress on health outcomes. METHODS: Data from a statewide case-control study of 2,378 Missouri mothers are used to examine the relationship of perceived stress, pregnancy attitudes and major life events as psychosocial risk factors on very low birth weight (i.e., birth weight lower than 1,500 g). Such births are contrasted with moderately low birth weight births (those weighing between 1,500 and 2,499 g) and normal-birth-weight infants (those weighing 2,500 g or more). A stepwise logistic regression model is used to control for all study and control variables. RESULTS: The risk of very low birth weight is one and one-half times greater if the mother perceived that she "almost always" felt stress during her pregnancy. The regression model confirms that besides perceived stress, several other factors are independently associated with an increased risk of very low or moderately low birth weight. For example, getting back with a husband or partner or experiencing a major injury accident or illness were associated with an elevated risk of low birth weight (odds ratio, 1. 7), as was pregnancy denial (1.4-1.6) and unhappiness about the pregnancy (1.3). On the other hand, a few factors (taking out a mortgage or loan, having a close relative die and having a mistimed pregnancy) appear to have reduced the odds of low birth weight (odds ratio, 0.5-0.8). CONCLUSIONS: Interventions with pregnant women, especially those assessing perceived stress and attitudes toward the pregnancy, have the potential to improve pregnancy outcomes. Additional prospective research with pregnant women on the origins and effects of stress, including the biological effects of stress, is needed.

Health care perceptions of mid-western urban-dwelling African-American women.

As a part of a comprehensive women's health needs assessment performed in Missouri, two focus groups were conducted with urban-dwelling African-American women. Ten African-American women 18 to 39 years of age comprised one group and 10 African-American women 40 to 74 years of age comprised the other group. Participants discussed major health concerns and issues related to service access. Although similar responses occurred between groups, major concerns such as reproductive issues in the younger women and chronic diseases in the older women, were clearly age-related. Participants commented on impediments to health care and adequacy of services. The Missouri Department of Health will use these findings in planning group-specific health interventions and services.

Violence victimization experiences of pregnant prisoners.

The violence victimization histories of pregnant incarcerated women were studied in relation to those of pregnant health department patients in North Carolina. Prisoners were twice as likely as health department patients to have experienced both physical and sexual violence compared to no violence, and over three times more likely to have experienced both types of violence compared to only one type. Implications for research and program development are noted.

The role of perceived stress on prenatal care utilization: implications for social work practice.

Data from the National Institute of Child Health and Human Development/Missouri Maternal and Infant Health Survey on about 2,828 mothers were used to examine the relationship between perceived stress and prenatal care utilization. Major life events that contribute to stress also were examined in relation to adequacy of prenatal care. Women who received inadequate prenatal care were more likely to have reported that they almost always felt stress during pregnancy. Odds ratios were statistically significant for women who were not black and Medicaid recipients but not for black women and women who were not covered by Medicaid. Social work intervention for stress reduction on behalf of pregnant women has the potential to contribute to improved prenatal care utilization, but further analysis of the kinds of stress women experience will enhance social work's ability to target specific interventions.

Pregnancy intentions may not be a useful measure for research on maternal and child health outcomes.

PIP: The findings of three researchers about pregnancy intendedness as a measure for understanding maternal and child health outcomes were evaluated. Studies have linked unintended pregnancy to some behaviors and to negative birth weight. Several issues undermine the validity of intendedness as it is presently measured, such as recall bias implicit in retrospective queries about intention; and pregnancy intention as a complex concept. Moreover, discrepancies between the stated and actual contraceptive practice of women also complicated the issue of intention status. Also, the issue of mistimed versus unwanted pregnancy presented another problem. Thus, intendedness may be too complex to quantify and measure accurately.^ieng

Prenatal lactation advice and intention to breastfeed: selected maternal characteristics.

This study uses data from the NICHD/MMIHS to examine the relationship among maternal characteristics and (a) whether mothers were asked by their prenatal providers to consider breastfeeding and (b) mothers' prenatal plans on how to feed their infants. Only 37% of the study population reported that their providers advised them to consider breastfeeding. Proportions of women who received prenatal advice to breastfeed and who intended to breastfeed were higher among married, Caucasian non-Hispanic, primiparous mothers, and women who were not enrolled in WIC. Women who received advice to breastfeed had significantly higher rates of planning to breastfeed (61.1%) than women who did not receive this advice (34.7%; p < 0.005). Efforts to meet the DHHS Healthy People 2000 objective for 75% of women to breastfeed in the early postpartum period will require a concentrated effort by prenatal providers to help women overcome their resistance to breastfeeding by offering support and encouragement.

Pregnancy intentions, pregnancy attitudes, and the use of prenatal care in Missouri.

OBJECTIVES: This study uses data from 2378 mothers of live-born infants from the NICHD/Missouri Maternal and Infant Health Survey to examine the relationship between pregnancy intention and adequacy of prenatal care. METHODS: Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies as well as additional measures of women's attitudes about their pregnancies. Odds ratios for inadequate prenatal care and its component parts (initiation of care and receipt of services) were calculated using multiple logistic regression in separate models and in a combined model for the measures of intention and attitude. RESULTS: Women's attitudes about their pregnancies were associated with inadequate prenatal care, including both inadequate initiation of care and inadequate receipt of services. Traditional measures of intendedness were significantly related only to inadequate initiation of care. Women who were unhappy about the pregnancy (OR = 1.44), unsure that they wanted to be pregnant (OR = 2.81), or denied their pregnancies (OR = 4.82) were more likely to have inadequate prenatal care than women who did not have these attitudes. Women who were unhappy about being pregnant (OR = 1.86), unsure that they wanted to be pregnant (OR = 3.44), or who denied the pregnancy (OR = 6.69) were more likely to have inadequate initiation of care. Women who were unsure that they wanted to be pregnant (OR = 1.95) or who denied their pregnancies (OR = 2.47) were more likely to have received inadequate care once they had entered care. CONCLUSIONS: This study suggests that attitudes about pregnancy may be a psychosocial barrier to women obtaining early and continuous prenatal care. Pregnancy attitudes should be assessed and appropriate services provided to improve women's utilization of prenatal care. New measures of pregnancy attitude, beyond the traditional intention measures, can be useful in assessing pregnancy wantedness and identifying women to target for these services.

Beliefs concerning contraceptive acquisition and use among low-income women.

Despite the availability of a wide variety of safe and effective contraceptives, unintended pregnancy remains a problem of considerable social and public health concern. This qualitative, descriptive investigation was based on Ajzen's Theory of Planned Behavior. The study examined attitudinal and normative beliefs, as well as perceived control factors that may affect a woman's intention to acquire and use specific contraceptive methods. The study sample consisted of 42 low-income women of reproductive potential. In face-to-face, audiotaped interviews, open-ended questions were used to elicit salient beliefs that affected these women's decision making about contraceptive acquisition and use. Respondents named embarrassment as a factor influencing condom acquisition and use; concerns about potential risks and side effects were a major deterrent to use of hormonal contraceptives. Implications for practitioners and public policy are suggested.

PIP: Despite the availability of a wide range of safe and effective contraceptives, unintended pregnancy remains a considerable social and public health problem in the US. More than half of all pregnancies in the US are unintended, and of those, 1.6 million are aborted and 1.5 million are carried to term. A qualitative, descriptive study was conducted based upon Ajzen's Theory of Planned Behavior, examining the attitudinal and normative beliefs, as well as perceived control factors which may affect a woman's intention to acquire and use specific contraceptive methods. The study sample was comprised of 42 low-income, reproductive-age women of mean age 23.4 years. Study respondents cited embarrassment as a factor influencing condom acquisition and use, while concerns about potential risks and side effects were a major deterrent to the use of hormonal contraceptives. Implications for practitioners and public policy are considered.

The relationship between prenatal health behavior advice and low birth weight.

OBJECTIVES: The purposes of the study were (a) to examine the relationship between the health behavior advice recommended by the Public Health Service Expert Panel on the Content of Prenatal Care and the risk of low birth weight and (b) to describe the type and frequency of health behavior advice offered to a group of pregnant women. METHODS: The authors used data from the National Institute of Child Health and Human Development/Missouri Maternal and Infant Health Survey, a follow-back survey of women who had delivered very low birth weight infants and of matched control subjects who had delivered moderately low birth weight and normal birth weight infants. Frequency distributions for different types of prenatal health behavior advice were examined for the 2205 participants, and logistic regression analyses were used to determine whether there was a relationship between birth weight and receiving the advice recommended by the Expert Panel. RESULTS: Only 10.4% of mothers reported receiving all seven types of health behavior advice recommended by the Expert Panel. Women who did not receive all seven types of advice were 1.5 times more likely to deliver a very low birth weight infant than a normal birth weight infant. CONCLUSIONS: Further research is needed to better understand the relationship between health education and birth weight.

Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status.

The relationship between pregnancy wantedness and adverse pregnancy outcomes was studied using data from 2,828 mothers who participated in the Missouri Maternal and Infant Health Survey. The wantedness of a pregnancy was measured using traditional classifications of mistimed and unwanted, as well as additional measures gauging how the woman felt about the pregnancy while she was pregnant. Fifty-eight percent of the very low birth weight infants and 59% of the moderately low birth weight infants resulted from unintended pregnancies, as did 62% of the normal-birth-weight infants. Logistic regression showed that mothers of very low birth weight infants were significantly more likely than those who had a normal-weight baby to report that they had felt unhappy about the pregnancy (odds ratio of 1.53). Very low birth weight was also associated with early denial of the pregnancy (1.54). Odds ratios associating these two unwantedness categories with low-birth-weight babies were higher among Medicaid recipients than among women not receiving Medicaid. Associations between very low birth weight and the denial variable were also significant among white women when very low birth weight outcomes were compared with normal outcomes, but there was no significant association among black women. There were no significant associations between low birth weight and the traditional unwantedness variables.

PIP: This study examines the relationship between pregnancy wantedness and adverse pregnancy outcomes among 2828 mothers who participated in the Missouri Maternal and Infant Health Survey. The survey was designed as a population-based case-control study of very low birth weight infants born to Missouri residents during December 1, 1989, and March 31, 1991. Infants of moderate and normal birth weight were the controls. Stillbirths were included, but multiple pregnancies were excluded. 36% of the sample were in-patients, 38% were Black, 62% were White, 23% were teenagers, 54% were in their 20s, 52% were married, and 52% lived in a major metropolitan area. 45% of mothers qualified for Medicaid. 779 women gave birth to a low birth weight infant, 799 gave birth to a moderately low birth weight infant, and 800 gave birth to a normal birth weight infant. 450 infants were stillbirths. Pregnancy wantedness was defined by traditional measures of mistimed and unwanted pregnancies as used in the NSFG and some newer measures, such as feelings about being pregnant. Six measures were used: unintended (mistimed and unwanted), mistimed, unwanted, unhappy about the pregnancy, unsure about the pregnancy, and denial of the pregnancy. Logistic regression analysis reveals that the odds of a pregnancy being unwanted if the baby was of low birth weight were greater for the following factors: smoking during pregnancy, maternal age, race, education, health status, pre-pregnancy weight-for-height, parity, infant mortality, and in-patient status at the survey date. The sample included 42% of mistimed pregnancies, and 15% each reported the pregnancy as unwanted, unhappy, or a denial. Birth weight outcomes did not vary by age or race. Low birth weight did not differentiate the wantedness of pregnancies using the timing-wantedness scale, but did distinguish on the happiness scale and denial measures.

Therapeutic effects of water and milk for acute alkali injury of the esophagus.

STUDY BACKGROUND: Alkali ingestions cause progressive and devastating injury to the esophagus by liquefaction necrosis. However, the therapeutic efficacy of water or milk dilution for alkali-induced esophageal injury has not been determined. This study used our previously reported model of alkali-induced esophageal injury to evaluate the effectiveness of water and milk dilution. HYPOTHESIS: Early dilution with water or milk is efficacious in decreasing esophageal damage from alkali exposure. METHODS: The esopgagi of 75 Sprague-Dawley rats were harvested, and each end was cannulated with a 20-gauge catheter. Specimens were maintained in an oxygenated saline solution (at 37 degrees C) during a 60-minute experimental period and then fixed immediately in 10% Formalin solution for histologic examination. Esophagi from six experimental groups (total of 60) were perfused with 50% NaOH solution at time 0. Water or milk dilution was performed immediately at 0 minutes, 5 minutes after injury, and 30 minutes after injury. Blinded pathologic examination was performed using a score of 0 (no injury), 1 (minimal), 2 (moderate), or 3 (severe) for the following six histologic categories: epithelial viability, cornified epithelial cell differentiation, granular cell differentiation, epithelial cell nuclei, muscle cells, and muscle cell nuclei. RESULTS: Positive and negative controls showed expected outcomes. Significant progressions of injury over time were seen for every histologic category for both water and milk dilution. The injury scores for the milk-treated group at 0 minutes were less than or equal to the injury score for the water-treated group for all categories. However, these differences were significant only for the cornified epithelial cells. CONCLUSION: Early dilution therapy with water or milk reduces acute alkali injury of the esophagus and supports use of these forms of emergency treatment.